SPECIALTY WORKSHOPS – ATTENDEE INFO ONLY

Prescreening is involved, please contact the CARE office at 586-541-0033 for more information.
If you fill out this form, a CARE program coordinator will follow up with you regarding your request.

PERSONAL INFORMATION

First Name: Last Name :

First Name Parenting Partner:
Last Name Parenting Partner:

Address: City: Zip:

Daytime Phone: Evening Phone:
Email:

School District:

How may we contact you? Phone Postcard E-mail

When we contact you may we identify ourselves as CARE and indicate you are taking a parenting class?
Yes No

Yes, I would like to receive CARE's FREE newsletter, Stepping Stones.

How did you hear about us?

Comments:

The following information will be used for statistical reporting only to our funders and will not be used in conjunction with your name or other personal information.

Name of Parenting Partner (if registering as as couple):

School District (that you live in):

Gender:

Age group:

Race/Ethnicity:

If childcare is available for the workshop you are registering for, please provide the following information:

Name of Child:	Age:
Name of Child:	Age:
Name of Child:	Age:
Name of Child:	Age:
Name of Child:	Age:

WORKSHOP INFORMATION

Which workshop would you like to register for? (Select one below)